Blood Test Could Revel Bipolar Disorder

[Phyllis]

http://www.msnbc.msn.com/id/23337532/

Blood test could reveal bipolar disorder
Method that could diagnose, assess patients also raises ethical question
By Steve Mitchell
MSNBC contributor
updated 5:01 p.m. ET, Mon., Feb. 25, 2008

A blood test could be used to diagnose and assess the severity of certain mental illnesses, such as bipolar disorder, according to a new study. But some experts think this raises ethical concerns about prying into a person's mental status.

Lab tests that can accurately detect mental illnesses have long been considered the “Holy Grail” of psychiatry. Currently, bipolar disorder and other conditions such as depression are diagnosed based on the patient's description of their symptoms and the physician's judgment, sometimes making it difficult to get an accurate diagnosis or determine the severity of a patient's condition. But now researchers have shown that 10 genes that can be detected in the blood could provide a better way to assess a patient.

“Patients aren’t sure how ill they really are, and neither is the clinician — sometimes dismissing their symptoms, sometimes overestimating them,” said Dr. Alexander Niculescu, III, a psychiatrist at the Indiana University School of Medicine in Indianapolis, who led the research published Tuesday by the journal Molecular Psychiatry. “Having an objective test for disease state, disease severity, and especially to measure response to treatment, would be a big step forward.”

More work remains to be done to confirm these findings, Niculescu said, adding that tests could hit the market in as little as five years.

The goal of the new study was to identify genes or biomarkers that could be used to track the severity of the symptoms of mania or depression in people already diagnosed with bipolar disorder, but these same genes could ultimately be turned into a test to make an initial diagnosis, he said.

Niculescu, who is also working on identifying biomarkers for diagnosing anxiety and stress as well as hallucinations in schizophrenia, said the bipolar findings could be the dawning of a new age in psychiatry. “It would put psychiatry on par with other medical specialties,” he said.

This could be especially helpful for ensuring a patient is getting the right medication. Bipolar patients are sometimes first seen by a physician during one of their low periods. Consequently, they may be misdiagnosed with depression and prescribed antidepressants, which can trigger a dangerous manic state. A blood test that could be used to monitor the patient might enable physicians to catch this mood elevation before it was too late.

“This may be especially important in children and adolescents, who are hard to diagnose for sure using clinical criteria only, and in whom mood states can change fast, sometimes dangerously so,” Niculescu said.

Beyond the stigma
Dr. Carlos Pato, chair of the psychiatry department at the University of Southern California School of Medicine in Los Angeles, thinks a test for mental illness should be viewed no differently than a test for other medical conditions, such as diabetes or heart disease risk.

“We should look beyond the stigma of a mental illness because the most important thing is to have a very clear diagnosis to get the best treatment for the patient,” Pato said.

Genetic testing for disease has long been controversial, but Art Caplan, director of the Center for Bioethics at the University of Pennsylvania and an msnbc.com columnist, said a genetic test for mental state could intensify that debate.

“We're likely to see much more controversy with genetic testing when it's about behavior, mental states and personality characteristics than when you're testing for cancer risk or prostate problems,” Caplan said.

The tests are particularly concerning if they could be used to screen for mental illness in the workplace or for college admittance, Caplan said. Other controversial areas include requiring people pass a blood test for mental competency to purchase a gun or for high sensitivity jobs, such as police officer or to enroll in the military.

Genes predict mood state
In the new study, designed to assess the severity of the disease, Niculescu's team first drew blood samples from 29 bipolar patients (27 men and two women) who were also asked about their mood level at the time of collection.

[Phyllis]

I don't understand how this can be controversial, I think this could help prevent mis-diagnosis immensly!

[Lurker]

I like you do not understand the problem. I suppose the stigma that surrounds the sickness. There could be people who don't want to know, I for one am glad that we are making progress.
                                             Lurker

[Paz]

I think it is the stigma that surrounds the sickness...I wish they would have been able to give me a simple blood test. Just think of all the pain & mental suffering that could have been avoided!
 Paz.

[Brian]

I don't understand how this can be controversial, I think this could help prevent mis-diagnosis immensly!

For the same reasons genotyping is controversial. People are afraid, for example, that insurance companies might do genetic testing before offering coverage, eliminating people that have genetic indicators for anything from heart disease to diabetes. The same is true in this case: suppose employers start requiring blood tests as a means of excluding people that may have mental issues, or insurance companies require blood tests to determine whether or not you're an acceptable risk. As of now, they can only do this with diagnosis, which means they're taking risks on all the people that haven't been diagnosed with some mental disorder.

[Lurker]

Now that is something that hadn't even crossed my mind genotyping, thanks Brian.
                                         Lurker

[Brian]

I probably worry more about how government might use such measures. For example, our government has recently passed laws to prevent anyone previously diagnosed with "mental illness" from owning a gun. On the surface, it seems like it might be worthwhile, but the definition of "mental illness" is so vague that it could be used for adults that may have been diagnosed as ADHD when they were kids, soldiers diagnosed with PTSD after coming home from war, or even people diagnosed with stuff like social anxiety disorder.

If they have a method of verifying "mental illness" with a blood test, it will be that much worse; and it might even stand to reason that it's extended to other things the government controls, like driver's licenses or business licenses.

That may seem paranoid, but consider they already verify sobriety via breath/blood test; now imagine mental illness is determined to be the equivalent of "driving while impaired" and they can confiscate your driver's license.

"Sorry, the breathalyzer indicates you're having a manic episode. You have the right to remain silent. If you can't afford a psychiatrist, one will be appointed for you."